Expand access to bariatric surgery

Guidelines state that individuals may qualify for bariatric surgery if they have a BMI of 40 kg/m², or a BMI of 35 kg/m² or more with a significant obesity-related health problem, such as high blood pressure or type 2 diabetes. Bariatric surgery achieves long-term weight loss, with individuals maintaining a ~17% decrease in body weight after 20 years. Moreover, bariatric surgery leads to improvements in obesity-related disease. However, despite its effectiveness, only a small proportion of those eligible undergo surgery. There are many reasons for this discrepancy including a lack of awareness of the procedure’s effectiveness and safety, prolonged and bureaucratic application processes, and perceptions and stigma related to the surgery. The most salient reason is insufficient funding, leading to a long NHS wait list; it is not currently possible to operate on every individual that meets the criteria.

NHS services and funding are devolved in Wales, but funding is impacted by the Barnett Formula (the formula ensures that any change in English public spending announced for a devolved area, like the NHS, is reflected by a change in the block grants). The All Wales Weight Management Pathway 2021 aligns its qualifying criteria to those of the NICE guidelines for bariatric surgery. The new 2021 All Wales Weight Management Pathway has been designed to address inconsistent implementation of bariatric surgery across the seven Health Boards (which was identified in 2014 by a Senedd Inquiry) by providing a single pathway. 

NHS services and funding are devolved in Scotland, but funding is impacted by the Barnett Formula (the formula ensures that any change in English public spending announced for a devolved area, like the NHS, is reflected by a change in the block grants). In Scotland, the decision to undertake bariatric surgery is jointly made between clinicians and patients, taking account of relevant guidance, Health Board criteria and the patient’s individual circumstances, including their fitness for surgery. NHS services and funding are devolved in Scotland, so any funding for expanding access to bariatric surgery would be agreed and administered by the Scottish Government via NHS Scotland.  

Changes in the prevalence of people living with obesity

Table 1 shows the percentage reduction of adults moving from a BMI greater than 30 into a healthier BMI category following introduction of this policy (five-year follow up). After five years of policy implementation, 0.4% of adults in England would move from a BMI of greater than 30 to a healthier BMI category.

The low rate of change is explained by the fact that this policy targets individuals with a very high BMI score. Hence, the policy would result in a large number of people moving from a BMI of 35+ to a healthier BMI of 30–34.9, which would result in improved health outcomes, but would not result in living with a BMI of <30 (our outcome of interest).

Cost over 5 years

We estimated that this policy would cost the governments approximately £250 million over five years

We commissioned HealthLumen to estimate the cost of the policy to both industry and governments over a five-year period. 

Table 2 below shows a breakdown of costs. The direct costs to the governments are estimated at approximately £250 million. This includes infrastructure costs in the first year for the building of new facilities in the first instance, followed by the average annual cost of conducting surgery on double the current number of patients (i.e., approximately 6,500 to 13,000). Please see cost calculations appendix for more details.

Total annual benefit

We estimated that this policy would have an annual benefit of approximately £0.2 billion

Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of approximately £0.2 billion per year. Approximately two-thirds of this saving would benefit individuals (via quality-adjusted life years, and informal social care). The remaining third relates to savings that benefit the state via NHS treatment costs, productivity and formal social care. See our Methods page for more information about the cost breakdowns. 

This figure is a very conservative estimate of the savings as it only includes benefits accrued for individuals who fall under the BMI threshold of 30 after five years. There would be additional cost savings associated with individuals moving from the BMI category of 35+ to the BMI category of 30–34.9, however we did not include this in our model.